Provider Demographics
NPI:1053942144
Name:ELLIOTT, SADIE LEIGH
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:LEIGH
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E PROSSER RD LOT 71
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-3154
Mailing Address - Country:US
Mailing Address - Phone:307-275-1908
Mailing Address - Fax:
Practice Address - Street 1:300 E PROSSER RD LOT 71
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-3154
Practice Address - Country:US
Practice Address - Phone:307-275-1908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator